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July 24, 2009

Under The Knife

Back in Action

by Will Carroll

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Yeah, I'm back. The surgery went well and while I'm not 100 percent yet, I hate not "playing." So let's skip the sentimentality and get right to it. Powered by hydrocodone and coffee, on to the injuries:

Brandon Inge (7 DXL)
If Inge is telling us that he's playing on a substantially torn patellar tendon, I'm stunned that he can even function, but he told the Detroit Free Press that he has a 75 percent tear. Kevin Rand clarifies this for us later in the article: Inge has a 75 percent tear of the middle third of the tendon. That's exactly the part that was often removed and used to reconstruct a torn ACL. I don't want to discount Inge's pain, but if that section ruptured, he could be functional. The rest of his talk about manning up and playing for the fans smacks a bit of arrogance, but yes, you could say he did carry the team for a while this year. Inge's function and pain levels are going to have to be watched, with maintenance becoming the rule for him going forward. Given the tight race in the AL Central, this is one of those small things that chip away at a team. An injury that costs a club as much as a half of a win could be the difference.

Lance Berkman (15 DXL)
I'm sorry, but "Puma" just makes me think of something like this, while Berkman will always remind me more of something like this. Still, this breed of cat is usually not that injury-prone, but Berkman has had occasional problems with his legs. His latest, a calf strain, finally made the Astros push him to the DL. The calf injury was said to be a mere annoyance just days ago, but he never made any progress with it, and the team elected to make the retroactive move that should have him ready at the minimum. It's a slight tell this close to the trading deadline, and at a time when the Astros are publicly saying they're buyers.

Jose Guillen (60 DXL)
Apparently, kicking himself in the butt may have hurt more than his ego. That's not how Guillen actually strained his LCL ... wait, wait, wrong sport, you're not here for cycling stuff. His LCL (lateral collateral ligament, or more properly the FCL, for fibular collateral ligament), one of the two stabilizing ligaments on each side of the knee, this one being the one on the outside. The Grade 2 sprain is pretty severe, but the news of it confuses me, given the mechanism; these types of sprains usually happen with an outside force acting on the inside of the knee. A common occurrence comes up with soccer tackles, when a player comes sliding in and catching a leg, though even in those cases the ankle is usually the weak link anatomically. This one's easily diagnosed, both manually and by MRI, so maybe the key here is in the muscle strain. Did something give in the secondary stabilizers, popping and letting all the force go laterally? I'm just not sure, and given the team involved, I'm not expecting further clarity. Given their diagnosis, Guillen will miss at least six weeks, which puts his season in jeopardy.

Edinson Volquez (70 DXL)
Dick Pole said that Edinson Volquez went through his workout at "68 percent." Volquez countered that it was "72 percent." Neither number comes with much context, so why the precision? If I had to guess, I would say that the order for the session was to throw at about 70 percent, or under the 75 percent mark, a number that's key because that's the point where research has shown that force begins to transfer from the muscles into the tendons and ligaments. Keeping Volquez below that threshold allows him to throw without taxing the elbow's structure. The problem is, it doesn't test the things that were the problem to make sure he's progressing functionally. That should come soon.

Kevin Slowey (45 DXL)
Joe Crede (20 DXL)

Ron Gardenhire is worried about Slowey's wrist and possible cascade injuries; the wrist has "chips," which are more likely chip fractures rather than the more traditional bone chips we often think of with pitchers. This affects him most on his breaking stuff, making Gardenhire worry that his pitcher will adjust his mechanics and cause problems in his shoulder or wrist. In his last "healthy" start on June 19th, only 10 of his 90 pitches were breaking balls. That's a pattern that holds, so even eliminating those doesn't seem to be a big effect. We have to assume then that the problem isn't just with breaking balls, which makes anticipating Slowey's comeback tough. Give Gardenhire some points here, though, because what he's doing makes sense on both stathead and medhead levels, although he's getting to it by a different methodology. Suffice to say that the Twins will be watching Slowey's Saturday start at Triple-A closely. The news isn't as good for Crede, as his shoulder was painful enough to send him to Lewis Yocum. That visit and testing will determine whether or not he'll head to the DL. A decision is scheduled to come today, but the recent signing of Mark Grudzielanek gives the Twins an option to turn to.

Chris Carpenter (0 DXL)
Someone in the media asked me about Carpenter's workload, specifically referencing the Verducci Effect. The answer is counterintuitive enough to bear repeating here. As with the Injury Nexus, the VE is something that's age-limited, so Carpenter, despite his change in workload, really doesn't fall within the rules of that particular rule of thumb. Despite an increase of more than 100 innings, there's really no predictive value for a veteran pitcher coming off of two lost years, except perhaps as a reminder not to give long extensions to pitchers in their 30s.

Dustin McGowan (180 DXL)
It's another injury to the Jays' pitching staff, but this one will slide under the radar when it comes to the counting stats. The Jays now don't sound sure that McGowan will ever come back, making a knee surgery the least of his concerns. He did have one a few weeks ago, but it was a simple clean-out of some torn cartilage, and he should be back to rehabbing soon. It is a setback for a guy who didn't need yet another obstacle to overcome along the way, and it serves as something of an object lesson. Pitching injuries aren't completely illuminated by the stats we have available, and even in a situation like this it's a reminder that there's also a cumulative effect of arm injuries, especially ones that come so young. Having an elbow get Tommy John'd at 22 might not be a career-ender, but it's not a good predictor either, especially in this organization. They head into the trade deadline and likely the offseason once again not knowing the root of all their pitching problems, an unknown that should really should unsettle ownership.

Jose Reyes (90 DXL)
John Maine (110 DXL)

The Mets injury situation is well chronicled, so I'm going to point to two recent injury stories and say "tread carefully." Both the media environment and the need to handle injuries in the bright lights of that environment can cause some skewing. Sure, Reyes has made some progress, but is it really news that he'll come back without being 100 percent? Almost all players come back with some deficit, absent a situation where the team has no reason to get a player back and can act with pure caution, and with no result-oriented balance to consider. The Mets are almost at that point, as they slowly fall further behind the Phillies. Reyes' return would help take some pressure off the medical staff and the front office, but his recent progress still puts him on track for mid-August. With Maine likely out for the rest of the season and heading to see Jim Andrews for a confirmation, the Mets' season spirals further out of the playoff picture. Maine's problems are more than just a case of his pushing too hard; they're reminders that even in a pennant race, pushing the costs forward might only make it hurt more.

Quick Cuts: Listening to Steve Stone during Mark Buehrle's perfect game was like a master class in the art of pitching. ... Ryan Dempster won't come off the DL for a Sunday start, but he is expected back in the middle of next week. ... The Phillies lost both Chad Durbin and J.C. Romero to arm injuries; neither is considered serious, with their lead in the standings allowing the team to use the DL. ... The Nats insist that shutting down Jordan Zimmerman for a month is purely precautionary. If by that they mean, "there's no need to push him", they're right. ... Troy Glaus had some back issues, playing only once in Memphis. He'll go to Springfield now, to keep him at "home." ... Conor Jackson is making some progress in his recovery from Valley Fever. The Dbacks hope to get him back before September 1, but probably won't shut him down either way. ... Vladimir Guerrero will be limited to DH for the rest of the season, which might cost him some at-bats overall. ... The M's like how Adrian Beltre looks taking grounders in pre-game drills, but also admit that he doesn't have full range of motion in his shoulder yet. It's hard to get a read on exactly when Beltre will be back, though it looks like it will be a bit sooner than expected. ... Alex Gonzalez didn't have a great rehab assignment with the bat, but the Reds will still activate him today. ... Brian Buscher was scratched because of bad sushi. You have to think that's going to draw a fine in Kangaroo court.

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